Is Prostate Surgery Better for Low Grade Cancer than Active Surveillance?

Is prostate surgery better for low grade cancer than active surveillance? According to a recent study, men who undergo radical prostatectomy after being on active surveillance have outcomes that are similar to those of men with low-risk prostate cancer who forego active surveillance and choose radical prostatectomy. These findings were presented at the American Urological Association’s annual meeting in Atlanta, Georgia, on May 20, 2012.

Active surveillance (watchful waiting) is a treatment option for prostate cancer that is frequently chosen by older men who have non-aggressive cancer, based on the theory that they are more likely to die of other causes before the cancer threatens their lives. Younger men who have low-risk, low-grade prostate cancer often chose active surveillance as a way to delay treatment and the associated side effects.

In this Canadian study, investigators evaluated the outcomes of men who chose active surveillance and then underwent radical prostatectomy and compared them with men with low-risk disease who chose immediate radical prostatectomy rather than active surveillance (Group 1).

The researchers also compared active surveillance men who progressed to Gleason 7 with men who had similar disease who had immediate prostatectomy (Group 2) to identify whether men on active surveillance had a worse outcome.

The average time men stayed on active surveillance before undergoing radical prostatectomy was 35.2 months. Comparison of men in active surveillance who later had prostatectomy with men in Group 1 revealed the men who stayed on active surveillance had worse cancer stage, Gleason grade, and rates of extracapsular extension (spread of prostate cancer beyond the prostatic capsule).

However, active surveillance patients who underwent a radical prostatectomy after they progressed to Gleason 7 had outcomes similar to men in Group 2. Men who are considering active surveillance should discuss the potential outcomes with their physician before making a treatment decision.

Read more in our Prostate Cancer Health Center.